What We Do

We believe everyone everywhere should have the health care they need to thrive. That’s why we work every day to improve the performance of health workers around the world and strengthen the systems in which they work.

In Dublin, some aspect of gender was central to four of the conference sessions, and a new Gender Equity Network, coordinated by the World Health Organization (WHO) and Women in Global Health, made up of research, advocacy, and implementation institutions, has already begun work on a two-year plan of action.

This is a far cry from the marginal status of gender equality at the 2013 Third Global Forum on HRH in Recife, Brazil.

But I remember a time—as recently as 2014—when the findings I had submitted to a well-known peer-reviewed journal concerning patterns of gender discrimination in health education and employment settings were politely declined, on the grounds that the subject matter was “too dark.”

As I mused about possible ways to make the subject of gender discrimination and inequality less “dark,” a more intrepid journal stepped into the breach and published the results.

This publication presents evidence on the reasons for the gender imbalances in global health roles and senior representation, all of which points to embedded bias and processes of continuous gendering that reproduce societal inequalities in health workplaces, and that it is therefore necessary to target the organization itself as the main site of change. Strategies include:

organizational gender analysis

naming the stereotypes that reinforce gender power relations of subordination and dominance

special principles, measures, and enabling conditions to deinstitutionalize gendered privilege and disadvantage, ultimately to catalyse organizational change that makes room for women’s leadership in global health

As peer-reviewed journals, academics, HRH practitioners, and global conferences catch up with field research and allow more heterodox findings into the mainstream, they will reveal to HRH practitioners and policy-makers the full range of factors driving the less-than-adequate health worker pipelines, health workforce attrition, and the abridgements of women’s ability to access opportunities for leadership and participation in the health careers of their choice.

For instance, our multimethod formative assessment of sexual harassment in Uganda’s health sector found that supervision and district recruitment systems in Uganda’s public health sector were rife with quid pro quo sexual harassment, a form of workplace violence and gender discrimination.

Sexual harassment undermines effective health sector leadership, management, and governance, and Uganda’s Ministry of Health wants to address it. The supposed enforcers of national regulations are key perpetrators, as supervisors may use performance appraisals to settle scores for refusing sex, or may favor those who submit to demands for sexual favors. Refusal results in victimization and unfavorable work conditions.

Sexual harassment is linked to resignations, punitive transfers, staff conflict, demotions, or denial of promotion to leadership jobs for those women who refuse the sexual quid pro quo. Reporting involves a high likelihood of secondary victimization.

In response to these findings, the ministry sponsored a national dissemination meeting in early November and convened a multisectoral working group to design a pilot system for sexual harassment prevention and response to protect health workers’ safety, security, and human/ labor rights. This will be piloted in 2018.

And our 2017 gender analysis of women’s leadership in supply chain management in Ethiopia—which used surveys, key informant interviews, focus group discussion, and analysis of personnel data—documented striking vertical and horizontal segregation of the Pharmaceuticals Fund and Supply Agency’s workforce, as well as gender-related factors that contribute to women’s underparticipation in supply chain jobs in varied and senior roles. These include:

a heavy, mostly unshared burden of family responsibilities that contend with full-time supply chain work

lack of enabling conditions in workplaces to integrate work and family responsibilities and breastfeeding

bias against women in leadership positions

The study helped identify priority action items to address these factors and strategies to further women’s leadership.

Some may still call these study results dark. But as the academy, peer-review journals, and HRH policy-makers come to grips with gender discrimination in the health workforce, the field of human resources for health will come of age—and become more effective.